I have spinal stenosis. Should I have surgery or not?
NEJM MAY 31,2007
Spinal stenosis is the most common reason for back surgery in people over 65. Slipped vertebra (called degenerative spondylolisthesiss) occurs in women over 50 and has no symptoms. Bone and soft tissue narrow the spinal canal. When walking or standing, there is pain in the butt or legs. Sitting or curling up the back usually eliminates the pain. It is also often found in patients without symptoms that have MRI studies for other reasons.
A large study was reviewed in the New England Journal of Medicine to evaulate results combined from several medical centers. The study was called SPORT. 150 patients had surgery and another 150 did not.
When MRIs confirmed the problem and symptoms were present for at least 12 weeks, it was found that there was no advantage in doing surgery. There also was no harm not doing surgery..
Those who had surgery noted their back pain was relieved in 33% of the cases and 55% also had leg pains disappear. Ten percent who had surgery had tears in the dural canal and 12% were reoperated in two years?
Those who coped out of surgery had more cortisone epidurals, had similar physical therapy, and had no activity restrictions. This may have accounted for their improvements similar to the surgically treated patients.
What is your decision?
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